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Summary of the impact

Research conducted by UEL's Drugs and Addictive Behaviours Research Group
(DAB) and the UEL Institute for Research in Child Development (IRCD) from
1990-2012 has provided key information about the neuro-psychological risks
of the use of the drug MDMA (Ecstasy).This information has been used by
the US and UK governments, medical professionals and public information
organisations. The research was included in the UK government Advisory
Council on the Misuse of Drugs (ACMD, 2009) review of MDMA effects
and informed government and public debate on the legal classification of
MDMA. It has also supported associated debates around the potential
harmful effects of MDMA. Subsequent media and public engagement with those
debates has contributed to increased public awareness of the effects and
risks of MDMA and engaged new audiences with important social and
scientific issues. More recent research has informed parents and medical
practitioners about the potential harmful effects of MDMA on specific
aspects of infant functioning when taken during pregnancy.

Underpinning research

The psycho-biological effects of MDMA (ecstasy), particularly in terms of
its `recreational' use and effects on the cognition and mood of adult
users, have been studied at UEL since 1990. Research in this area was
instigated by Professor Andrew Parrott (at UEL until 2004; now Swansea)
and has been continued by members of the Drugs and Addictive
Behaviours group (DAB), including Dr Lynne Dawkins (2005-current),
Dr John Turner (1995-current), and Dr Kirstie Soar (2003-current). More
recently Professor Derek Moore (UEL 1995-current) and Dr Julia Goodwin
(1997-2008, now NPEU, Oxford) from the UEL Institute for Research in
Child Development (IRCD) have also worked collaboratively with
Turner and Parrott, together with Singer (Case Western Reserve
University), to explore the effects of MDMA exposure in pregnancy on
infant development.

Parrott, Turner and Soar have published numerous widely-cited empirical
and review papers, including some of the first papers to demonstrate
impaired memory functioning in young recreational ecstasy (MDMA) users
compared with aged-matched controls [e.g. 1]. The group led the way in
examining both the immediate and longer-term effects of MDMA use on
cohorts of young recreational drug users in typical `rave' conditions.
These studies suggested that long-term ecstasy users were significantly
impaired on immediate and delayed word recall [1]. The team has continued
to investigate the nature of these cognitive/ memory impairments, using a
variety of cognitive tasks to measure executive planning, vigilance,
psychomotor performance and specific aspects of memory [2, 3]. The work
has been published in high impact psychopharmacology journals, and is
influential and highly cited in the field.

In 2002, an approach made by Professor Singer of Case Western Reserve
University (USA) culminated in the collaborative (UEL / Case Western
Reserve) Drugs And Infancy Study (DAISY). Co-led at UEL by Moore
and Parrott with Turner and Goodwin, the DAISY project was the first, and
to-date only, prospective study to investigate the impact of MDMA use
during pregnancy on infant development. Through prospective interviews
with pregnant poly-drug users, the study ascertained likely patterns of
poly-drug exposure across trimesters, showing that infants are most likely
to be exposed to MDMA in the first trimester (not later) and that cannabis
and tobacco use are likely to feature alongside MDMA use [4]. The key
post-natal effect on human infants was shown to be differences in the
quality of motor functioning at four months in infants exposed to MDMA,
compared to other polydrug-exposed babies [5], a finding that corresponds
with the serotonin-related effects found in animals exposed in utero. The
DAISY study also went on to show that these negative motor effects are
still evident through to 12 months of age in MDMA-exposed babies [6].

The work also suggested that MDMA may contribute to differential sex
ratios; women who took part in the study were more likely to give birth to
male than female babies [5]. These unprecedented findings have been
published in Psychopharmacology, Teratology and Paediatric journals, and
have reached a wide audience of psychology, psychiatry, medical
professionals, as well as the wider public.

References to the research

The following research outputs appeared in peer-reviewed journals with a
median impact factor of 3.28. Collectively, they have received over 650
citations (information retrieved from Google Scholar, July 2013).

The co-production of [5] and [6] was supported by a jointly-shared grant
of $2.66m from the US government's National Institute on Drug Abuse
(NIDA/NIH, DA14910; 09/30/01 - 07/31/07)

Details of the impact

The research described above has been used to inform national and
international political, professional and public debate about the risks of
MDMA use. It has provided key evidence influencing UK and US governmental
debate about the drug's legalisation and allowed medical professionals and
specialist information websites to provide better-evidenced and more
accurate advice to groups, including pregnant women and recreational drug
users. Contributions to media discourse have supported both the delivery
of more accurate media coverage of issues relating to the effects of the
drug and increased public awareness of those issues.

Informing US policy makers, health professionals, and public about the
potential harmful effects of MDMA.

Parrott and Turner's publications from 1998 through to 2004 feature on
the US government's National Institute of Health, National Institute
on Drug Abuse (NIDA) website. This site provides information
resources that are authoritative, respected and used by a wide range of US
policy makers, health professionals, drug users and members of the US
public as core information on the potential harmful effects of drugs on
adult functioning. Four UEL-authored papers, including [1], are cited on
the website as key pieces of research evidence for the harmful effects of
MDMA [a].

Informing UK government debate about the legal classification of MDMA.

In the UK the same work, outlining the potential neurological and
psychological risks of MDMA use, has informed government debate and
decisions relating to the legal classification of MDMA, and specifically
to its status as a Class A versus Class B drug. In 2008, Parrott, Turner,
Soar, and Milani made invited contributions to the 2009 Home Office Advisory
Council on the Misuse of Drugs (ACMD) review of MDMA, which cites
[b]. Parrott was one of only eight expert witnesses called to give oral
evidence; Turner, Soar and Milani also provided written evidence on the
negative effects of the drug. Papers published by the UEL group —
including [1] and [3] — are referenced frequently in the report [b].
Whilst the ACMD report recommended that MDMA be re-classified to Class B,
Home Office Ministers in fact rejected this recommendation, a decision
informed in part by the work of the UEL team, which evidences the
long-term negative effects of MDMA on memory and mood.

Parrott's subsequent extensive engagement in public debate with the Chair
of ACMD (David Nutt) about the use of evidence, and conclusions of the
ACMD report [c], ensured that the research not only influenced policy, but
also enhanced public awareness and understanding of some of the most
important issues relating to the use of the drug. In September 2012,
Parrott took part in Channel 4 television's "Drugs Live" programme, in
which he debated the potential negative effects of MDMA on adults with
David Nutt and Val Curran. Parrott made a significant contribution to the
programme in proposing the arguments for the potential `side-effects' of
MDMA if used in therapy. In so doing, he referred to studies undertaken at
UEL (both by him whilst he was here and, subsequently, by the rest of the
team) that have reported long-term negative effects on memory and mood.
Moore was also an invited member of the expert audience for that
programme, which reached a peak audience of more than 2 million viewers
[d]. A You Tube link to the programme had received in excess of 5,000
views in July 2013.

The reach of these impacts on UK public awareness of, and engagement
with, issues pertaining to the drug legalisation debate was extended by
subsequent contributions to international public and media discourses on
that topic, with Parrott, Turner and Moore all contributing to media
debates engaging both UK and overseas audiences. On 28 September 2012, for
example, Moore contributed to a debate with Val Curran about whether the
Drugs Live programme had given a sufficiently clear message about the
negative effects of MDMA generally and about the importance, more
specifically, of ensuring that young women recognise the danger that its
use might pose to unborn babies dangers before they are aware of their
pregnancy. The debate was broadcast on the Voice of Russia UK, the Russian
government's international radio broadcasting service. A You Tube link to
the programme had been accessed more than 600 times by July 2013 [e].

Raising awareness among international public audiences about the
dangers of MDMA use in early pregnancy.

Since their publication in 2012, findings from the DAISY study — the
first in the world to report the effects of MDMA on motor and cognitive
functioning in human infants — have likewise been widely covered by
popular and news media [f]. They were, moreover, also reported in detail
on leading pregnancy information websites in the UK and USA [e.g. g].
Prior to the publication of the research findings, such sites gave only
very generic advice against illicit drug use during pregnancy, and had no
firm evidence of the negative effects of MDMA specifically on the
long-term development of babies. One of the most popular UK pregnancy
websites, BabyCentre UK, has since updated their drug advice pages to make
reference to the DAISY study's findings about the effects of MDMA on
infant motor function [g]. The site, which is visited millions of times
each month by pregnant women or those planning pregnancies, refers
specifically to a paper from the study [5].

Improving understanding among medical and health professionals

As well as being used to inform general public audiences, the DAISY
findings were widely reported and discussed on medical websites in the UK
and US. Between 28 February and 2 March 2012, that coverage included
discussion of the results published in [5] on US News' HealthDay
site, MedicineNet.com, and DrugRehab.us; the article also received
a particularly high number of views on Medical News Today, where
it was listed as the `editor's choice' [h].

Publications by UEL researchers have led to invitations for them to share
their research findings and the expert knowledge accruing from their work
with a wide range of medical health professionals, through contributions
to live events. Parrott's expertise remains much in demand among medical
professional groups, and he continues to draw on evidence gathered during
his time at UEL in meeting that demand. Throughout the period of the DAISY
project — which ran up to and through 2008 — Moore accepted numerous
invitations to present lectures and workshops on the study for audiences
of paediatricians and health professionals, including at the British
Association for Community Child Health. These led to an invitation to
provide a chapter (published in 2011) on the potential pre-natal effects
of MDMA for a book in the prestigious Clinics in Developmental Medicine
series (McKeith) [i]. This provided access to data on the potential
harmful effects of MDMA, including preliminary data from the Daisy study,
for professionals from other disciplines, particularly including
paediatricians, neurologists and general practitioners,

Raising awareness among drug users of the potential harmful effects of
MDMA

The UEL team's work on MDMA has featured regularly, not just on TV news
(e.g. ITV News, Channel 4 News and the BBC's World Service) and in the
national press, but on independent websites set up to inform drug users
[j]. It has also been presented at the Club Health Conference in Ibiza
(2008) and Prague (2011), where the research results were used to inform a
non-academic audience of policy-makers, law enforcement agencies, a wide
range of health professionals, nightclub owners and clubbers. Work has
also been presented at the National Drug Treatment Conference to policy
makers, clinicians and service users.

Sources to corroborate the impact

[a] For reference to the research — including [1] — on the US Government
NIDA advice web pages: http://1.usa.gov/19iHgB1
notes 2, 16, 18 and 22.

[b] The 2009 Home Office Advisory Council on the Misuse of Drugs (ACMD)
confirms the provision of written evidence by Turner and Soar (p. 44). The
significance of the contribution made by UEL work to the legalisation
debate is suggested by the proportion of report references (6 of 81) to
work authored here, including [1] and [3]: http://bit.ly/18JALCU
p. 37.

[c] There are many examples of Parrott's widespread engagement in public
debate about the ACMD consultation and evidence base for the proposed
re-classification of MDMA. These included coverage by the Daily Telegraph
(e.g. http://bit.ly/19X3YhC) and BBC
(http://bbc.in/17BGM8P), as well as an
open letter published in Addiction Today (http://bit.ly/1aOyhIr).
Parrott had, by this point, left UEL, but drew extensively on research
conducted here in making his case.

[d] For Parrott's discussion of the evidence (much of it based on work
done at UEL) for the harmful effects of MDMA on "Drugs Live: The Ecstasy
Trial" (27 September 2012): http://bit.ly/1aMwhyj.
The YouTube link to the programme, showing 5500+ views at July 2013, is: http://bit.ly/16SdrIR

[e] The YouTube link to Moore's debate with Curran on the Voice of Russia
UK, showing 600+ views at July 2013, is: http://bit.ly/1asLIiT